Health

Whether it’s a move, loss of work, death of a loved one or involvement in a tumultuous relationship, 1 in 5 pregnant women has three or more stressful events in the year leading up to her delivery.

According to a recent National Institutes of Health network study, pregnant women who experienced financial, emotional, or other personal stress in the year before their delivery had an increased chance of having a stillbirth.

Stillbirth is the death of a fetus at 20 or more weeks of pregnancy. According to the National Center for Health Statistics, in 2006, there was one stillbirth for every 167 live births. Those rates are much higher for black women, and researchers say stress may be a contributing factor.

The NIH study asked more than 2,000 women a series of questions, including whether they had lost a job or had a loved one in the hospital in the year before they gave birth.

Whether or not the pregnancy ended in stillbirth, most women reported having experienced at least one stressful life event in the previous year. Women reporting a greater number of stressful events were more likely to have a stillbirth.

Non-Hispanic black women were more likely to report experiencing stressful events than were non-Hispanic white women and Hispanic women. Black women also reported a greater number of stressful events than did their white and Hispanic counterparts.

Some of the stressful events were more strongly associated with stillbirth than were others. The risk of stillbirth was highest:

• For women who had been in a fight (which doubled the chances for stillbirth)

• If she had heard her partner say he didn’t want her to be pregnant

• If she or her partner had gone to jail in the year before the delivery

“At prenatal visits, screening is common for concerns such as intimate partner violence and depression, but the questions in our study were much more detailed,” said co-author Uma Reddy, M.D., M.P.H., also of National Institute of Child Health and Human Development. “This is a first step toward cataloguing the effects of stress on the likelihood of stillbirth and, more generally, toward documenting how pregnancy influences a woman’s mental health and how pregnancy is influenced by a woman’s mental health.”

Researchers found that 83 percent of women who had a stillbirth and 75 percent of women who had a live birth reported a stressful life event.

Two stressful events increased the odds of stillbirth by about 40 percent, the researchers’ analysis showed.

A woman experiencing five or more stressful events was nearly 2.5 times more likely to have a stillbirth than a woman who had experienced none. Almost 1 in 5 women with stillbirths and 1 in 10 women with live births in the study reported recently experiencing five or more stressful life events.

“This reinforces the need for health care providers to ask expectant mothers about what is going on in their lives, monitor stressful life events and to offer support as part of prenatal care,” said study co-author Marian Willinger Ph.D. acting chief of the Pregnancy and Perinatology Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development.